Okullardan Aile Sağlığı Merkezlerine Geçiş: 13 Yaş Td Aşılama Düzeyi ve Engeller

Abstract

Türkiye'de 3 Haziran 2020 tarihinde yürürlüğe giren yönetmelikle birlikte, okullarda mobil hizmet üniteleri ile toplu olarak uygulanan 13 yaş difteri-tetanoz rapel doz aşıları, bireysel başvuru üzerine aile sağlık birimlerine devredilmiştir. Bu çalışma, bu politika değişikliğinden sonra Şanlıurfa il merkezindeki ergenler arasında Tetanoz-Difteri aşılama kapsamını ve aşı yaptırmama nedenlerini araştırmak üzere planlanmıştır. Bu çalışma, Ekim 2023'te Şanlıurfa Haliliye ilçesinde yürütülen kesitsel ve vaka-kontrol çalışmasıdır. Evren, Tetanoz-Difteri aşısı için uygun olan 13 yaş ve üzeri bireylerden oluşmuştur; örneklem büyüklüğü mevcut literatüre dayanarak hesaplanmıştır. Yüz yüze anketler uygulanmıştır. Aşılanmamış katılımcılar vaka grubuna, aşılanmış olanlar ise kontrol grubuna yerleştirilmiştir. Tetanoz-Difteri aşılama kapsamı %77.8 olup Dünya Sağlık Örgütü'nün ≥%90 hedefinin altındadır. Aşı olmamanın en yaygın nedenleri "aşı gerekliliği konusunda farkındalık eksikliği" (%51.3) ve "zaman eksikliği/unutkanlık" (%27.7) idi. Diğer çocukluk çağı aşılarını yaptırmak, COVID-19 aşısı olmak ve bir sağlık uzmanından bilgi almak daha yüksek aşılama oranları ile ilişkilendirilirken, medyayı ana bilgi kaynağı olarak göstermek, aşı karşıtı haberlere katılmak, daha önce aşı olma konusunda tereddüt/reddetme öyküsü ve erişim engelleri aşı olmama ile ilişkilendirildi. Bu bulgular, yetersiz bilgi, erişilebilirlik zorlukları ve güvensizliğin aynı anda ele alınması gerektiğini göstermektedir. Hem okul destekli mobil ekiplerin hem de aile sağlık merkezlerinin kullanıldığı hibrit bir hizmet modeli, Tetanoz-Difteri kapsamını artırabilir ve genel aşılama oranlarını iyileştirebilir.

Keywords

• Adolesanlar
• difteri–tetanoz pekiştirme dozu
• birinci basamak sağlık hizmeti
• aşılama kapsamı
• aşı tereddütü

From Schools to Family Health Centers: 13-Year-Old Td Vaccination Coverage and Barriers

Abstract

With the regulation that entered into force on 3 June 2020 in Türkiye, the age 13 diphtheria-tetanus booster dose vaccines, which were administered collectively in schools with mobile service units, were transferred to family health units based on individual application. This study was planned to investigate the Tetanus-Diphtheria vaccination coverage and reasons for non-vaccination among adolescents in Şanlıurfa provincial center after this policy change. This study is a cross-sectional and case-control study conducted in Şanlıurfa Haliliye district in October 2023. The population comprised individuals aged 13 years who were eligible for Tetanus-Diphtheria vaccination; sample size was calculated based on available literature. Face-to-face questionnaires were administered. Participants who remained unvaccinated were placed in the case group, while those vaccinated were assigned to the control group. The Tetanus-Diphtheria vaccination coverage was 77.8%, falling below the World Health Organization’s ≥90% target. The most common reasons for not receiving the vaccine were “lack of awareness about the need for vaccination” (51.3%) and “lack of time/forgetfulness” (27.7%). Completing other childhood vaccinations, receiving a COVID-19 vaccine, and obtaining information from a healthcare provider were associated with higher vaccination rates, whereas citing the media as the main information source, agreeing with anti-vaccine news, a history of previous vaccine hesitancy/refusal, and access barriers were linked to non-vaccination. These findings indicate that insufficient information, accessibility challenges, and mistrust must be addressed simultaneously. A hybrid service model using both school-supported mobile teams and family health centers could increase Tetanus-Diphtheria coverage and improve overall vaccination rates.

Keywords

• Adolescents
• diphtheria–tetanus booster
• primary health care
• vaccine coverage
• vaccine hesitancy

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